R Bismuth subnit., 3v; Creosote, gtt. xv; Mucil. acaciae, f3i; Aq. menth. pip., q.s. ad f3iii. M. Sig. - Teaspoonful every one or two hours.

1/8 grain of morph. sulph. was administered hypodermically to alleviate as much as possible the abdominal suffering.

The impending exhaustion and the failing heart's action I endeavored to combat with a free administration of alcoholic stimulants in combination with moderate doses of tincture of digitalis both by the mouth and under the skin.

In order to invite the circulation of the blood to the ice-cold surface of the body, heated bricks and bottles filled with hot water were placed in bed around the patients.

Analyzing each symptom as it arose, and carefully observing the effects of the poison on the system, I formed the opinion that the toxic element contained in the noxious fungus eaten by these people was narcotic in its nature and spent its force on the nerve centres, especially selecting the one governing the function of respiration and the action of the heart.

Acting upon this conclusion, I began, in the early part of my treatment, subcutaneous injections of sulphate of atropine in frequently-repeated doses, ranging from 1/180 to 1/90 grain. The injections invariably were followed by a perceptible improvement in the patient; the heart's action became stronger, the pulse returned at the wrist, and the respiration increased in depth and fulness.

Through the agency of this remedy, supported by the other measures adopted, three (or sixty per cent.) of the patients recovered.

The lessons I draw from this experience are:

1. The poisoning produced by this variety of toadstool is slow in manifesting its effects.

2. That it destroys life by a process of asthenia.

3. That in atropine we have an antidote, and it should be pushed heroically from the earliest inception of the action of the poison.

I have the honor to remain

Yours very respectfully,

J. E. Shadle, M.D.


In reply to the queries, Was atropine administered in all the cases? and What was the total amount administered to each? Dr. Shadle responded as follows:

Shenandoah, Pa., October 29, 1885.

My dear Mr. McIlvaine:

Yours of the 27th I have received. The two questions you ask me therein I see are very important, and they should be answered as fully as possible. I am sorry I overlooked the matter in my report.

Before attempting an answer, it is well for me to note right here that Mrs. B. , the neighbor, did not eat very much of the toadstool stew; Mrs. R. and Mr. F. each ate about the same quantity - from one and one-half to two platefuls. This is according to Faris's statement. But the two fatal cases - Thomas R. and Mrs. F. - tried to see which could eat the most, and consequently got their full share of the poison. The cat mentioned before had about a tablespoonful of the broth, and they tell me she was very sick. Whether or not she died is not known.

Now as to the treatment by atropine, I think I can approximate a pretty correct statement in reply to your queries. Not knowing that atropine was considered an antidote, I began its employment in the treatment of these cases from the physiological knowledge I had of the drug relative to its action in other diseases in which there was heart-failure and embarrassed respiration.

When I saw the U. S. Dispensatory suggested it, I of course felt it my duty to use it, as I could find nowhere anything else mentioned as an antidote. I feel convinced that it was by means of the atropine that I saved three of the five patients. Why do I think so ? Because whenever I would administer the remedy the patient rallied, the pulse returned at the wrist, the heart-sounds became stronger, and the respiration increased in strength and fulness. What more conclusive evidence do I want than this to show as to how the agent was acting ?

When I first saw the patients - twelve hours after the ingestion of the poison - their symptoms were alike, one suffering as much as the other (August 31). I began the use of the alkaloid in the evening of the same day, when I saw the powers of life giving way, the heart failing, and the respiration becoming shallow. It was used in all the cases as follows: